Department for Transport

Roads: Damage

Lord Bradshaw: To ask Her Majesty’s Government, further to the Written Answer by Lord Ahmad of Wimbledon on 25 June (HL579), whether the currently used methods of calculating road wear are subject to adjustment to account for roads that are structurally unsound, vehicles that are unevenly or excessively loaded, vehicles that exceed speed limits, and inclines, roundabouts and other road features.

Lord Ahmad of Wimbledon: The methods for calculating road wear on the Strategic Road Network take account of the cumulative effects of vehicle loading and speeds. The most important factor is vehicle loading. Road inclines, roundabouts and other road features are not explicitly taken into account, but the overall approach is based on much empirical evidence from national and international sources, which shows how pavements wear in real life conditions.   The change to the mix of traffic is regularly monitored to adjust the wear factor. It is supplemented by monitoring vehicle axle loads at sample spots on the network, such as roads near port entries, freight distribution centres and weigh-in-motion sites. Current design and maintenance standards have enabled development of long life pavements on most of the network, requiring no substantial structural work so long as the road surface is replaced at appropriate points. Current road condition survey programme and maintenance strategies aim to ensure that there is no structurally unsound road pavement.

Home Office

Licensing Laws

Lord Brooke of Alverthorpe: To ask Her Majesty’s Government whether they plan to review the decision taken in February not to allow local councils to set their own local alcohol licensing fees as provided for in the Police Reform and Social Responsibility Act 2011.

Lord Bates: The Government’s position is the same as that set out in the response to the consultation on locally set fees, published on 26th February of this year. The Local Government Association is taking forward work to provide better evidence of licensing authority’s costs. The Government will review whether to implement locally-set licensing fees when the necessary evidence is available.

Immigration Rules

Lord Green of Deddington: To ask Her Majesty’s Government what documentation a non-European Union citizen resident in another EU country requires in order to (1) enter, and (2) reside in, the United Kingdom.

Lord Bates: A non-EU citizen who is not a family member of an EU citizen is required to present a valid national passport or other document which satisfactorily establishes identity and nationality and where required by the Immigration Rules additionally a UK visa or evidence of Leave to Remain in order to enter and reside in the UK.

Immigration Rules

Lord Green of Deddington: To ask Her Majesty’s Government what documentation a non-European Union citizen who is resident in another EU country, and is a family member of an EU citizen, requires to (1) enter, and (2) reside in, the United Kingdom.

Lord Bates: A non-EU citizen who is a family member of an EU citizen is required to present a valid national passport or other document which satisfactorily establishes identity and nationality along with evidence of their right to enter and reside in the UK as required by the Immigration (European Economic Area) Regulations 2006.

Illegal Immigrants

Lord Taylor of Warwick: To ask Her Majesty’s Government how they plan to tighten control of illegal immigration, in particular in the light of recent events at Calais.

Lord Bates: The Government is committed to maintaining a safe, secure and effective border. This includes a rigorous system of checks upon arrival. The Home Secretary and French Interior Minister Bernard Cazeneuve set out a number of commitments in a joint declaration, on 20 September 2014, to tackle problems at the port of Calais. This included £12 millio from the UK Government to help reinforce security.We continue to work with the French Government to implement the practical solutions that have been agreed. On 2 July, the Home Secretary and the French Interior Minister reaffirmed the determination of both countries to strengthen and complete their joint strategy to deal with this common challenge, including by increasing the intervention fund to secure access to the Channel Tunnel. We are also addressing the factors that pull illegal immigration to the UK, through the Immigration Act 2014. The Act puts the law firmly on the side of those who respect it, not those who break it. It does this by stopping migrants using public services to which they are not entitled, reducing the pull factors which encourage people to come to the UK for the wrong reasons, and making it easier to remove people who should not be here.The UK is also playing a leading role in pushing for comprehensive, long-term action through the EU and the UN to tackle the causes of illegal immigration and the organised trafficking gangs behind it, as well as increasing support and protection for those who need it in North and East Africa. Above all, we need to break the link between getting on a boat and achieving residence in Europe.

Former Prime Ministers: Security

Lord Stoddart of Swindon: To ask Her Majesty’s Government, further to the Written Answer by Lord Bates on 25 June (HL714), why information about the cost of security protection for former Prime Ministers and Deputy Prime Ministers could compromise the security of the individuals concerned; and whether such security protection extends to when they are abroad.

Lord Bates: I refer to my previous written answer: disclosure of such information could compromise the integrity of and affect the security of the individuals concerned. Disclosing such details would not only reveal tactical policing decisions, but would compromise the safety of those arrangements since it would enable those wishing to circumvent them to form an assessment of the level of policing and protection being provided. Decisions about the protective security of former Prime Ministers abroad are made by the Cabinet Office chaired, Royal and Ministerial Visits Committee for Overseas Travel.

Cabinet Office

Civil Servants: Training

Lord Hunt of Chesterton: To ask Her Majesty’s Government what plans they have to improve the co-ordination of training of United Kingdom civil servants with those in European Union and European Economic Area countries.

Lord Bridges of Headley: Civil Service HR co-ordinates training to provide for UK Civil Servants working in, or who need a working knowledge of, the EU and European Economic Area countries.

Life Peers: Public Appointments

Lord Pearson of Rannoch: To ask Her Majesty’s Government whether they have any plans to (1) refrain from making any new recommendations for new peerages for Liberal Democrats, and (2) make recommendations for new peerages for UKIP; and if not, why not.

Baroness Stowell of Beeston: I refer the noble Lord to my written answer of 23 June 2015 (HL371, HL372, HL373 and HL509), which I attach for ease of reference. Appointments remain a matter for the Prime Minister, who has committed to keeping party peers under review.



HL371, HL372, HL373, HL509
(PDF Document, 41.26 KB)

Department for Business, Innovation and Skills

Small Businesses: Audit

Lord Mendelsohn: To ask Her Majesty’s Government what data they used to estimate the savings made from enabling small businesses to decide whether their accounts need to be audited.

Baroness Neville-Rolfe: Data on company size and audit fees was sourced from the “FAME” database, Bureau van Dijk. The data was used for both of the final impact assessments approved by the Regulatory Policy Committee in the last Parliament on changes to the law to enable more companies to decide whether or not their accounts need to be audited. The impact assessment on the audit changes (including for small businesses) in the Companies and Limited Liability Partnerships (Accounts and Audit Exemptions and Change of Accounting Framework) Regulations 2012 is available at: http://www.legislation.gov.uk/uksi/2012/2301/impacts/2014/286 The impact assessment on all the changes in the Companies, Partnerships and Groups (Accounts and Reports) Regulations 2015 is available at: http://www.legislation.gov.uk/uksi/2015/980/impacts/2014/424   



Audit Changes
(PDF Document, 590.44 KB)




Changes in the Companies. Partnerships and groups
(PDF Document, 308.69 KB)

Transatlantic Trade and Investment Partnership

Lord Warner: To ask Her Majesty’s Government what assessment they have made of the potential risks in the United Kingdom to (1) public health, (2) public finances, and (3) small businesses, from the Transatlantic Trade and Investment Partnership (TTIP); and whether they are considering any opt-outs from TTIP for any sectors likely to be damaged by the agreement.

Lord Maude of Horsham: The Prime Minister, the European Commission and the US government have all confirmed that the EU-US Free Trade Agreement will pose no threat to the provision of key UK public services, such as NHS healthcare, and EU countries will be free to decide how they run their public health systems. The agreement could, however, benefit the UK economy by up to £10 billion a year in the long run, and should therefore benefit the public finances as well as businesses and workers. Small businesses in particular will benefit from removing unnecessary barriers to trade.

Transatlantic Trade and Investment Partnership

Lord Warner: To ask Her Majesty’s Government what legislation will have to be put before Parliament to give effect to the Transatlantic Trade and Investment Partnership in the United Kingdom.

Lord Maude of Horsham: The EU-US Free Trade Agreement is expected to be a mixed agreement to which the UK will individually be a party. In that case before it can come fully into force, it will be subject to agreement by each Member State. In the UK this does not require legislation, instead Parliament will receive the complete draft text of the agreement and can scrutinise it through debates in both Houses. We will not know for certain whether any implementing legislation will be necessary until the agreement is closer to completion.

Ministry of Defence

Gibraltar: Spain

Lord West of Spithead: To ask Her Majesty’s Government how many incursions into British Gibraltar Territorial Waters by Spanish vessels there were in June.

Earl Howe: In June 2015, there were 45 unlawful incursions by Spanish State vessels into British Gibraltar Territorial Waters (BGTW). The Royal Navy challenges all unlawful incursions. The United Kingdom also makes diplomatic protests to Spain in respect of these unlawful incursions, which are in violation of international law. These unlawful incursions are violations of, rather than threats to, UK sovereignty over BGTW.

Military Aid

Lord Craig of Radley: To ask Her Majesty’s Government, further to the Written Answer by Earl Howe on 1 July (HL754), what marginal cost amounts will be credited to the defence budget for providing such humanitarian assistance in Sierra Leone, Nepal and the Mediterranean; and, in each case, what percentage of the total cost of this assistance to the defence budget those marginal costs represent.

Earl Howe: The Ministry of Defence has received £28.8 million for the marginal costs associated with providing humanitarian assistance in Sierra Leone. While costs are still being refined, the Ministry of Defence expects to receive up to £5 million for marginal costs incurred in support to the Nepal earthquake relief, and up to £11 million for costs associated with the deployment of HMS Bulwark and Merlin helicopters to the Mediterranean for search and rescue activities.As there is a standing arrangement for the Ministry of Defence to recover the marginal costs associated with support to humanitarian assistance and disaster relief, the total costs are not available.

Saudi Arabia: Yemen

The Marquess of Lothian: To ask Her Majesty’s Government what support the United Kingdom is providing to the government of Saudi Arabia in its military campaign in Yemen.

Earl Howe: We are not participating directly in Saudi-led military operations in Yemen, but we are providing technical support, precision-guided weapons and exchanging information with the Saudi Arabian armed forces through pre-existing arrangements.In addition to the personnel who continue to provide support for equipment supplied, we have a small number of liaison personnel in Saudi and coalition air and maritime headquarters. This includes personnel in the Maritime Coalition Coordination Centre in the region supporting the delivery of humanitarian aid into Yemen.

Department for Work and Pensions

Employment: Autism

Baroness Uddin: To ask Her Majesty’s Government what efforts they are making to raise awareness of employing people with autism.

Baroness Uddin: To ask Her Majesty’s Government what steps they will take to ensure that organisations in the private sector employ people with autism.

Baroness Altmann: The Government is acting to raise awareness regarding employment of people with autism and to support people on the autism spectrum to take up employment. For example, The Government’s Disability Confident campaign works with employers at a national and local level to help them to understand the benefits of employing disabled people, and promote good practice in recruitment and employment of disabled people, including people with autism. DWP has worked in close partnership with the Hidden Impairment National Group (HING), a national network of disabled people, medical professionals/ academics and disability specific organisations to produce an ‘Uncovering Hidden Impairments’ toolkit. This resource supports organisations in both the private and public sectors to confidently recruit and retain talented individuals with hidden impairment conditions. The Department for Education is funding Ambitious about Autism (2015-16) to explore innovative ways of supporting young people with Autism to make the transition from school to further education, and the Autism Education Trust (2015-16) to promote the availability of training on Autism to schools, early years and further education staff, and to revise national standards for Autism provision and a competency framework for those who work with children with Autism. Government has supported the development by NIACE of an employer toolkit that includes information to help employers to understand the benefits of employing apprentices with disabilities, and to access support. We are currently working with Autism charities to build an autism network across DWP Jobcentre Plus Offices to ensure we can provide the best possible service to those with autism. We have worked with Community Service Volunteers to introduce the Job-Shadowing Work Placement Initiative for young disabled people. The first tranche was very successful with 65% of young people having autistic spectrum conditions The Government’s Autism Strategy, and the updated Statutory Guidance published in March 2015, sets out in detail how Government will support the autism agenda nationally.

Department for Communities and Local Government

Homelessness: Children

Lord Ouseley: To ask Her Majesty’s Government what are the implications for the education, health and well-being of children in homeless families; and what actions they propose to take to reduce the number of children in homeless families in bed and breakfast accommodation.

Baroness Williams of Trafford: Placing families in temporary accommodation avoids a homelessness crisis and means no child will end up on the streets. However, the Government has been clear that placing families with children in bed and breakfast accommodation for longer than 6 weeks is both unacceptable and unlawful and we recognise the disruption this can have on children. Authorities must by law consider the impact any change in the location of accommodation will have on a household such as proximity to education and medical facilities. A small number of authorities (5%) account for 80% of cases where the 6 week limit is exceeded. The use of bed and breakfast accommodation for families with children is less than a third of the peak it was in 2002.We provided funding to authorities so they could test innovative and sustainable approaches that would tackle this issue. The lessons learned have been disseminated to other authorities across the country.Households leaving temporary accommodation now spend on average 7 months less than they did in 2010.

Housing: Fires

Baroness Greengross: To ask Her Majesty’s Government what assessment they have made of the number of older people involved in house fires with an electrical source of ignition in England and Wales in the last five years for which figures are available.

Baroness Williams of Trafford: The Department has policy responsibility for England only. The following table shows the number of casualties aged 65 years old and over who were involved in dwelling fires attended by fire and rescue services in England, where there was reported to have been an electrical power source involved in ignition of the fire. There was incomplete data for 2009/10 so this has not been included: YearCasualties aged 65 and over  2010/111,1162011/121,1322012/131,0622013/14949 Casualties include fatalities, hospital admissions, and cases where first aid was administered or precautionary checks recommended. The ages of people involved are only reported when they are casualties, and so we do not hold information on the total number of fires involving older people. An electrical source of ignition has been interpreted as where the power source involved in the fire was reported as being electricity, although these figures will include incidents where the cause of the fire was not necessarily a direct result of the electrical source – for example, including careless handling, placing articles too close to appliances, and cooking. Data are as reported on the Incident Recording System (IRS) by fire and rescue authorities. 2009/10 was the first year of the IRS and totals are slightly underreported.

Crime

Lord Ouseley: To ask Her Majesty’s Government what assessment they have made of the levels of hate crime in the United Kingdom; and what assessment they have made of the implications of such crimes for community cohesion.

Baroness Williams of Trafford: The Government is committed to providing robust and transparent data on hate crime. We have seen significant improvements to hate crime data including the inclusion of hate crime in National Crime Statistics and the Crime Survey of England and Wales. The Government funds the National Community Tension Team which analyses hate crime, together with a wide range of information from local police areas and international events. They produce ‘Operation Element’ reports weekly to inform targeted threat assessments which inform the decisions of local managers. At times of increased tension this analysis will be boosted to produce more regular or detailed products. This process has been enhanced by national Information Sharing Agreements which allow for the mutual transfer of anonymous hate crime data with some civil society organisations. As well as the need to reduce the harm caused to victims, we recognise such crimes also have an effect on broader communities and can lead to community tension if not addressed early. In order to address these issues all relevant Ministers are represented on a cross-Government Hate Crime Programme which includes criminal justice agencies and an Independent Advisory Group made up of victims, advocates and academics.

Northern Ireland Office

Foreign Investment in UK: Northern Ireland

Lord Browne of Belmont: To ask Her Majesty’s Government what recent steps they have taken to encourage inward investment in Northern Ireland.

Lord Dunlop: The Government works closely with the Executive to attract inward investment to Northern Ireland. The Economic Pact, ‘Building a Prosperous and United Community’ delivered a Northern Ireland International Investment Conference at which the Prime Minister made the keynote address; the first ever joint UK-Irish trade mission with ministers from London, Belfast and Dublin; and corporation tax legislation which completed its Parliamentary stages and became law just before the General Election.

Rescue Services: Northern Ireland

Lord Rogan: To ask Her Majesty’s Government, further to the Written Answer by Lord Dunlop on 30 June (HL756), in each of the years 2010 to 2014, on how many occasions an air-rescue helicopter was flown from the Republic of Ireland to Northern Ireland to aid civil authorities.

Lord Dunlop: The number of taskings of helicopters from the Republic of Ireland to assist HM Coastguard both in maritime and inland incidents in Northern Ireland in each of the years 2010 to 2014 is shown below: 201010201148201241201336201426

Rescue Services: Northern Ireland

Lord Rogan: To ask Her Majesty’s Government, further to the Written Answer by Lord Dunlop on 30 June (HL755), in each of the years 2010 to 2014, on how many occasions an air-rescue helicopter was flown from the mainland to Northern Ireland to aid civil authorities.

Lord Dunlop: The number of taskings of helicopters from Great Britain to assist HM Coastguard both in maritime and inland incidents in Northern Ireland in each of the years 2010 to 2014 is shown below: 2010220111420128201313201414

Department of Health

Pancreatic Cancer: Diagnosis

Lord Aberdare: To ask Her Majesty’s Government what assessment they have made of (1) the number, and (2) the proportion, of pancreatic cancer patients whose diagnosis is made following an emergency admission; and how those figures compare with patients of other cancer types.

Lord Prior of Brampton: The Routes to Diagnosis study defines a methodology by which the route the patient follows to the point of diagnosis can be categorised, in order to examine demographic, organisational, service and personal reasons for delayed diagnosis.   Administrative Hospital Episode Statistics data are combined with cancer waiting times data, data from the cancer screening programmes and cancer registration data from the National Cancer Data Repository.   Using these datasets every case of cancer registered in England which was diagnosed in 2006-2010 is categorised into one of eight ‘Routes to Diagnosis’.   The methodology is described in detail in the British Journal of Cancer article Routes to Diagnosis for cancer - Determining the patient journey using multiple routine datasets, which can be found at the following link and is also attached.   http://www.nature.com/bjc/journal/v107/n8/full/bjc2012408a.html   Emergency presentations are defined as “an emergency route via A&E, emergency GP referral, emergency transfer, emergency admission or attendance.” More detail can be found in the attached technical document.   Data on all malignant neoplasms (excluding non-melanoma skin cancer) and pancreatic cancer was taken from the “Routes to diagnosis 2006-2010 workbook (a)” – this can also be found in the attached article.   The Emergency Presentation Route is the principle route to diagnosis for patients with pancreatic cancer. This reflects the lack of easily recognisable symptoms of early disease, with advanced disease often presenting with the acute onset of jaundice.   The percentage of emergency presentations ranges from 3% for melanoma to 63% for acute lymphoblastic leukaemia.   Table 1: Percentage of diagnoses by emergency presentation route, England, persons, 2006-2010  Number of casesNumber of cases by emergency presentation routePercentage by emergency presentation route ab(b/a)x100All malignant neoplasms(excl. non-melanoma skin cancer)1,272,584291,39123%Pancreas34,01216,46048% 



Routes to Diagnosis for cancer
(PDF Document, 735.09 KB)

Diabetes: Depressive Illnesses

Baroness Suttie: To ask Her Majesty’s Government what estimate they have made of the annual cost of diabetes-related depression to the National Health Service.

Lord Prior of Brampton: The Department has not made any estimate of the annual cost of diabetes-related depression to the National Health Service.   The National Institute for Health and Care Excellence (NICE) has estimated that approximately 15–25% of people with chronic physical health problems, such as diabetes, also meet diagnostic criteria for depression. This is reflected in NICE’s Diabetes in adults quality standard, which sets out that people with diabetes should be assessed for psychological problems which should then be managed appropriately. A copy is attached.

Immigrants: Tuberculosis

Baroness Suttie: To ask Her Majesty’s Government whether latent tuberculosis infection screening is incorporated into routine medical checks at immigration centres.

Lord Prior of Brampton: People admitted to immigration removal centres (IRCs) are not currently screened for latent tuberculosis infection (LTBI). However, a national partnership agreement between Home Office Immigration Enforcement (HOIE), NHS England and Public Health England (PHE) published in April 2015 committed all three organisations to work together to improve the pro-active detection, surveillance and management of infectious diseases in IRCs and improve capability to detect and respond to outbreaks and incidents. A copy of the ‘Partnership Agreement between Home Office Immigration Enforcement, NHS England & Public Health England’ is available at the following link and is attached.   http://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/04/hoie-partnership-final.pdf.   A working group on LTBI among detainees in IRCs is being established this summer by PHE (health and justice, travel and migrant health and tuberculosis (TB) sections) to explore these issues. This work will contribute to the overarching joint PHE and NHS five year TB strategy for England which was published in January 2015. A copy of ‘Collaborative Tuberculosis Strategy for England, 2015-2020’ is available at the following link and is attached.   https://www.gov.uk/government/publications/collaborative-tuberculosis-strategy-for-england.   Included among several identified areas for priority action are: tackling TB in under-served populations (including migrants and those in secure and detained settings) and systematic implementation of new entrant LTBI screening.   PHE will work to provide expert advice to NHS England and HOIE on how to implement LTBI screening in IRCs once this work has been completed. 



Collaborative Tuberculosis Strategy for England
(PDF Document, 1.43 MB)




Partnership agreement
(PDF Document, 357.17 KB)

Amyloidosis

Lord Willis of Knaresborough: To ask Her Majesty’s Government what progress has been made on setting up a study to image amyloid deposition in systemic amyloidosis using hybrid positron emission tomography-magnetic resonance imaging; where the study is located; how many patients have been recruited; when the study is expected to complete its initial work; and where the results will be published.

Lord Prior of Brampton: This is a single centre study at University College London Hospital. It has now been set up and one patient has been recruited and scanned. The current planned date for end of recruitment is 1 October 2016. It is anticipated that the data will be analysed and submitted for publication in a peer reviewed journal within a year of the end of recruitment.

Bone Marrow Disorders

Lord Willis of Knaresborough: To ask Her Majesty’s Government whether they will place in the Library of the House any publications resulting from the phase 3 clinical trials approved for the potential treatment of systemic amyloidosis or multiple myeloma; and what is the National Institute of Health Research’s assessment of progress in these areas.

Lord Willis of Knaresborough: To ask Her Majesty’s Government whether there are currently any trials for systemic amyloidosis in humans being conducted by the National Institute of Health Research charities or the commercial sector.

Lord Willis of Knaresborough: To ask Her Majesty’s Government which of the four phase 2 or 3 clinical trials for systemic amyloidosis approved since 2004 are still ongoing; and whether any of the trials have produced sufficient positive outcomes to encourage commercial development.

Lord Prior of Brampton: There are four trials for systemic amyloidosis that are designated as ‘ongoing’ in the United Kingdom. These are being conducted by two commercial sponsors, Millennium Pharmaceuticals Inc and A.T. Development Switzerland Sarl (two studies), and one non-commercial sponsor, European Myeloma Network.   Clinical trial sponsors are required to publish a summary of their trial results to the EU Clinical Trials Register within one year of their trial completing. At that point, these results will become publically available on the EU Clinical Trials Register   The Department of Health, which funds the National Institute for Health Research (NIHR), is a member of the National Cancer Research Institute (NCRI). NCRI Clinical Studies Groups (CSGs) bring together clinicians, scientists, statisticians and lay representatives to coordinate development of a strategic portfolio of trials within their field. All CSGs interact with clinical research networks, funders (including NIHR) and researchers to develop studies aimed at improving outcomes for patients. The Haematological Oncology CSG has a Myeloma Subgroup and its 2013-14 annual report that includes an assessment of progress in these areas is attached and available on the NCRI website at: http://csg.ncri.org.uk/wp-content/uploads/2014/11/NCRI-Haem-Onc-CSG-Annual-Report-2013-14.pdf.   We cannot comment on commercial considerations. When the results are known, the commercial potential of these trial’s products will be a matter for the respective trial sponsors. 



2013-14 Annual Report
(PDF Document, 1.12 MB)

Congenital Abnormalities

Lord Rooker: To ask Her Majesty’s Government what is the latest information they have regarding high risk groups suffering neural tube defects at birth.

Lord Rooker: To ask Her Majesty’s Government how the take-up of advice given on National Health Service websites about preventing spina bifida is currently monitored.

Lord Rooker: To ask Her Majesty’s Government how many live births where the child was diagnosed with spina bifida, hydrocephalus or anencephaly there have been in each of the past five years.

Lord Rooker: To ask Her Majesty’s Government whether the postcodes of mothers of babies born with congenital abnormalities are yet available on the British Isles Network of Congenital Anomaly Registers.

Lord Rooker: To ask Her Majesty’s Government what assessment they have made of the implications for health equality of their current policy regarding the prevention of neural tube defect-affected pregnancies.

Lord Rooker: To ask Her Majesty’s Government whether any independent scientific advisory committee has been commissioned to study the causes and consequences of neural tube defect-affected pregnancies.

Lord Prior of Brampton: Information on high risk groups suffering neural tube defects at birth is not collected centrally.   There are no current mechanisms in place for monitoring the take-up of advice given on the NHS Choices website about preventing spina bifida.   The British Isles Network of Congenital Anomaly Registers (BINOCAR) collects information about the mother and child, including postcode of residence, mother’s age, pregnancy length, pregnancy outcome, when and how the anomaly was identified and the details of each anomaly.   Information on congenital abnormalities including spina bifida, hydrocephalus and anencephaly is collected by the British Isles Network of Congenital Anomaly Registers. Data is currently available for 2009–2012.   The following table shows the number of live births for years 2009-2012   Number of cases, birth prevalence (per 10,000 total births) and 95% CIs according to congenital anomaly subgroup; six BINOCAR registers (coverage: 36% of births in England and Wales): 2009-2012 – Live Births 2009201020112012Congenital anomaly Spina bifida 31533444Hydrocephalus 48857284Anencephalus and similar 4416   In line with National Institute for Health and Care Excellence guidelines, health professionals use appropriate opportunities to advise all women who may become pregnant that they can most easily reduce the risk of having a baby with a neural tube defect by taking folic acid supplements. This information is also available on the NHS Choices website.   The Scientific Advisory Committee on Nutrition (SACN) was, however, commissioned to provide advice to government on the impact of folic acid fortification to improve the folate status of women and therefore reduce the number of pregnancies affected by neural tube defects. This built on previous advice from SACN’s predecessor the Committee on Medical Aspects of Food and Nutrition Policy in 2000. The Government is currently considering the recommendations that SACN made alongside other information sources, including the latest folate status data and expects to make an announcement on this in due course.

Pharmacy

Lord Hodgson of Astley Abbotts: To ask Her Majesty’s Government whether NHS England has recently received any reports of interruptions in the supply of drugs from United Kingdom pharmaceutical companies to United Kingdom pharmacies.

Lord Prior of Brampton: In the United Kingdom, responsibility for the security of supply of medicines lies with the Department of Health, rather than NHS England. The Department receives reports from the pharmaceutical industry about issues which may potentially interrupt the supply of drugs that may affect United Kingdom pharmacies on a regular basis. We work closely with pharmaceutical companies, NHS England and clinicians in order to mitigate the impact of any shortages on patient care.

Drugs: Exports

Lord Hodgson of Astley Abbotts: To ask Her Majesty’s Government whether they are aware of any United Kingdom pharmaceutical companies diverting the supply of drugs from the United Kingdom to overseas markets to take advantage of the strength of sterling.

Lord Prior of Brampton: The Government is aware of the parallel trade in medicines within the European Union, which is permitted under European legislation. The strong pound sterling makes it much less attractive for these traders to export from the United Kingdom to other member states and the export of medicines has therefore decreased in recent years.

Vitamin B12

The Countess of Mar: To ask Her Majesty’s Government what steps they are taking to find an alternative and reliable test to assess the vitamin B12 status of the population; and what level of false high results the current test provides.

The Countess of Mar: To ask Her Majesty’s Government whether they plan to review how pernicious anaemia and other symptoms of vitamin B12 deficiency in the United Kingdom population are diagnosed and treated, particularly taking into account the neurological and mental health impact of any failure to diagnose quickly and accurately; and, if not, why not.

The Countess of Mar: To ask Her Majesty’s Government what steps they are taking to ensure that a reliable test to assess the vitamin B12 status of the United Kingdom population is made available as a means to prevent serious and irreversible neurological damage before any mandatory fortification of flour with folic acid is introduced.

The Countess of Mar: To ask Her Majesty’s Government what assessment they have made of the frequency at which patients with pernicious anaemia require vitamin B12 replacement therapy by injection; whether they have any evidence that patients are purchasing additional supplies from unregulated sources; and whether they will review current guidance.

The Countess of Mar: To ask Her Majesty’s Government whether they have assessed the social and economic costs of misdiagnosis or late diagnosis of pernicious anaemia and other vitamin B12 deficiencies; and, if so, what they consider them to be.

The Countess of Mar: To ask Her Majesty’s Government whether they plan to replace the current test for human vitamin B12 status with the Active B12 (holotranscobalamin) test; and if not, why not.

Lord Prior of Brampton: The diagnosis and treatment of pernicious anaemia, the result of a vitamin B12 (cobalamin) deficiency, is well established and reported in the British Committee for Standards in Haematology (BCSH) guidance document, Guidelines for the diagnosis and treatment of Cobalamin and Folate disorders, which was updated in May 2014. A copy of the BCSH guidance document is attached. The BCSH operates independently of the Department and NHS England and produces evidence based guidelines for both clinical and laboratory haematologists on the diagnosis and treatment of haematological disease, drawing on the advice of expert consultants and clinical scientists practicing in the United Kingdom. It would be for the BCSH, not the Department, to consider whether any adjustments to current best practice, in the diagnosis and treatment of patients with pernicious anaemia were needed, including whether any new or additional tests were appropriate.   The BCSH guidance sets out that cobalamin status is the recommended first line diagnostic test. The Department has no data relating to false positive results in relation to the test. The guidance also states that clinical picture is the most important factor in assessing the significance of the test results.   When anaemia is diagnosed, most patients respond well to treatment through quarterly intramuscular injection of vitamin B12. Whilst some patients with pernicious anaemia might prefer to have more frequent injections, or for other forms of vitamin B12 to be self-administered, these are matters for individual patients to discuss with their general practitioners.   Although the Medicines Healthcare products Regulatory Agency is currently reviewing claims made by some clinics that are administering vitamins and minerals intravenously for nutritional therapy purposes, the agency has not encountered any clinics making claims to treat pernicious anaemia. In addition, the Department does not have any information regarding patients purchasing additional supplies of B12 from unregulated sources.   Regarding the mandatory fortification of flour with folic acid, the Scientific Advisory Committee on Nutrition recommended a number of measures to ensure monitoring and surveillance of the impact of fortification of flour, should it be implemented. This included appropriate systems to monitor any potential adverse effects, including cancer and a review of the evidence on benefits and postulated risks after five years. The National Diet and Nutrition Survey monitors folate intakes and the most recent data, which was published earlier this year, will be carefully considered alongside other information sources before any decision is made on mandatory fortification.   The Department has made no assessment of the social and economic costs of misdiagnosis or late diagnosis of pernicious anaemia and other vitamin B12 deficiencies. 



BSCH Guidance
(PDF Document, 318.95 KB)

Congenital Abnormalities

Lord Rooker: To ask Her Majesty’s Government when they expect the population of England to be covered by the National Congenital Anomaly and Rare Disease Registration Service.

Lord Prior of Brampton: The current plan for expansion of the Congenital Anomalies and Rare Disease Registration Service aims to achieve national coverage by April 2016, subject to review in the context of the forthcoming spending review.

Mental Health Services: Ethnic Groups

Baroness Lawrence of Clarendon: To ask Her Majesty’s Government what assessment they have made of the level of mental health resources and support currently available to young people from Black, Asian and Minority Ethnic backgrounds.

Baroness Lawrence of Clarendon: To ask Her Majesty’s Government what efforts they are making to address the lack of access to mental health services for young people from Black, Asian and Minority Ethnic communities.

Lord Prior of Brampton: The Department has not made an assessment of the level of mental health resources and support currently available to young people from Black, Asian and Minority Ethnic backgrounds. Commissioners and providers of NHS services are required to ensure that the services they commission or provide operate in such a way to meet the needs of diverse groups, including people from Black and Minority Ethnic communities.   The Children and Young People’s Mental Health and Wellbeing Taskforce considered the mental health needs of all children and young people. As part of this work, a specific group was set up to look at the needs of vulnerable groups and inequalities. A report from this group was published alongside the Future in mind report.   The Department is commissioning a new prevalence survey for children and young people’s mental health. We anticipate that the new survey will report on ethnicity, which would provide us with more up-to-date information on the mental health needs of children and young people from Black and Minority Ethnic groups.   Difficulties may arise preventing access to mental health services by members of some communities due to the stigma attached to mental illness among those communities. We believe that Time to Change, a joint anti-stigma campaign led by Mind and Rethink, is addressing this issue and we are considering how best to help.

Mental Health Services: Ethnic Groups

Baroness Lawrence of Clarendon: To ask Her Majesty’s Government whether they intend to make additional resources available to mental health services in Black, Asian and Minority Ethnic communities, and if so, what resources they will make available.

Baroness Lawrence of Clarendon: To ask Her Majesty’s Government what assessment they have made of early intervention and preventative mental health services and the extent to which these are used by Black, Asian and Minority Ethnic communities.

Baroness Lawrence of Clarendon: To ask Her Majesty’s Government, following the Ethnic Inequality and Mental Health Consultation by Lankelly Chase Foundation, what efforts they are making to address the dissatisfaction felt within the Black, Asian and Minority Ethnic mental health sector with the Government's lack of commitment to address ethnic inequalities in mental health.

Lord Prior of Brampton: Everyone should be able to access mental health services according to need. However, we know that there are inequalities in the access to mental health services. For example, older adults, men, Black, Asian and Minority Ethnic (BAME) communities and those who are Deaf are not accessing services in the numbers predicted by prevalence studies. The National Health Service is leading on work on equality of access. We are listening to people with experience of mental health within BAME communities and continuing to make the changes needed to ensure equality throughout mental health services.   There are no plans to make additional resources available for mental health services in BAME communities. However, planning requirements for 2015-2016 require clinical commissioning groups to invest additionally in mental health in line with the growth in their overall funding allocation, which should benefit all communities.   In July 2014, the Joint Commissioning Panel for Mental Health published guidance for commissioners of mental health services for those from black and minority ethnic communities which is attached and can be found at the following link:   http://www.jcpmh.info/wp-content/uploads/jcpmh-bme-guide.pdf   The Department has been working with NHS England and commissioners to disseminate this guidance which describes what ‘good’ mental health services for people from BAME communities look like.   One of the key priorities of the work in updating the Mental Health Act 1983 Code of Practice, which was published in January 2015, was to eliminate discrimination, including for people from BAME communities. The Department’s published Equality Analysis Equality for all: Mental Health Act 1983: Code of Practice sets out a range of additional guidance that has been included aiming to address concerns raised by BAME stakeholders and others. 



Joint Commissioning Panel - Mental Health guidance
(PDF Document, 1.94 MB)

Monitor: Employment Agencies

Lord Hunt of Kings Heath: To ask Her Majesty’s Government how many agency staff Monitor has used since 2010; and at what cost.

Lord Prior of Brampton: Monitor use agency staff to temporarily fill administrative and clerical roles according to the business needs of the organisation, providing cover for vacancy, holiday and sickness.   The table below shows Monitor’s approximate average headcount for agency staff between 2010-11 and 2014-15. The total cost over this period was £1.564 million including VAT.   To note, there is some discrepancy in the data as collection methodology changed in 2011, when it started to be collected monthly.   Figures for headcount and spend on agency staff:Average HeadcountCost, £000 incl VAT2010-115.5160**2011-128235**2012-1313385*2013-1412.54182014-1510.5366   Sum501,564Average10313 * Extrapolation of full year position from incomplete data ** Extrapolation based on trends

NHS England

Lord Morris of Aberavon: To ask Her Majesty’s Government what specific role NHS England has in supporting Clinical Commissioning Groups; and what plans, if any, they have to change this role.

Lord Prior of Brampton: Clinical commissioning groups (CCGs) commission the majority of NHS services in England. As such, NHS England is responsible for ensuring that every CCG can access excellent affordable commissioning support services. Its principal vehicles for delivering this are through the Lead Provider Framework for commissioning support which enables CCGs to draw down a range of support services from nine high quality providers and through the oversight of NHS Commissioning Support Units, which NHS England hosts.   NHS England also has a statutory duty to produce commissioning guidance, which CCGs must have regard to, and continues to promote good commissioning through its CCG assurance framework.   NHS England continues to review its support of CCGs to ensure they are well supported organisations. There are no immediate plans to change this offer.